Wednesday, October 26, 2016

Spontaneous Abortion

Since the medical, and insurance worlds live on definitions. Let's speak clinically.

Abortion: Death of the fetus or passage of products of conception (fetus and placenta) before 20 wk gestation.
Late Abortion between 12 and 20 wk gestation.

Nov 19 2010, according to my medical records, I had a late term spontaneous abortion.  I was at my 16 week check up.  I went to the appointment alone; Chris had class and work, and it was a routine 4 week check up with my midwife.  We had decided if our baby was a girl, we would name her Claire. Claire Elise Cope.  While I had initially been overwhelmed by the idea of having 3 kids so close together, I had become very attached to this baby and pregnancy.  I had very recently received a priesthood blessings promising me that the baby was going to continue to grow and be strong.  I had asked for a blessing, because my kids had been sick and I was worried I wouldn’t be able to have the energy to provide them with the care they had needed.  I remember finding it odd, that this promise had come to me, because I hadn't been worried about the pregnancy at all, just my constant tired pregnant mom with a 3 year old and 1 year old state needing energy and patience with sick kids.

Appointment day, I walk in and say hello to my midwife, Guy Cox. He pulls out the ultrasound machine and we get going. Minutes pass. More jelly. Small talk. A furrowed brow.  How am I feeling?  Have I had any pain or noticed anything amiss?  No, I answer. I’m feeling great.  Everything seems to be by the book.  He refers me to a doctor at the hospital.  He wants to be certain, but he can’t find a heartbeat.  He worries about the size of my baby.  It isn't measuring as large as it should at this time.  I look down at my body.  I have certainly grown.  I've been showing for quite some time now, and he is so reassuring that I nod, and make the drive to the hospital.  I call Chris. Something is wrong with the pregnancy. They aren't certain yet. Can he meet me soon?

I am called into the dr office.  It's colder here. I've never met this man before, but he's much older, and seems more clinical and rough around the edges than my midwife for sure.  It takes him seconds to confirm what my midwife spent about 20 minutes trying to conclude. My baby is dead.  My baby has been dead for quite some time. Around 13-14 weeks he surmises.  What?!
He gives me my options. I can elect to go home and give my body more time to figure out that the pregnancy is no longer viable, and have a very painful and possible incomplete delivery at home. In my bathroom most likely. Or, he can admit me, and they can start things now. He promises me an epidural and that I won't feel any pain.  It will be safer, because they will perform a D&C following the passing of the baby.  He is as kind as he can be.

Definition time:
Dilation and curettage (D&C) is a procedure to remove tissue from inside your uterus. Doctors perform dilation and curettage to diagnose and treat certain uterine conditions — such as heavy bleeding — or to clear the uterine lining after a miscarriage or abortion.  

I'm 26. I have had 2 full term pregnancies, and have miscarried two pregnancies already. They were both around 6-8 weeks.  It was more like a very heavy period than labor.  I'm assured doing this at home will be much more painful than what I've experienced in the past. And that I may not pass everything on my own since I'm so far along, and may need to come in anyway for the D&C.

We elect to be admitted.  I am given medication to start contractions. My mom arrives from Salt Lake. She has left her job early and come to be by my side. My mom had 6 live births, and lost 3 of her children as well.  She comes to stand as a witness to my pain, to hold my hand-attempting to share my sorrow, my grief, and the physical and emotional nightmare ahead of me.  I am not given the epidural I was promised. The dr instructions are missing his signature and he is in surgery.  Hours pass. Contracts worsen.  I am amazed that the pain of labor this early is just as horrible as when I had Ava at 39 weeks.  I hate labor.  My mom, a kind and patient person, is yelling at the nurses and staff. Where is my epidural. I should not be in this pain.  The forms are signed.  I am given my epidural.  It slowly begins, but before I lose all feeling, there is a rush.  My body stops contracting. I look at the nurse and say quietly, shaking, "something just happened."
I have given birth. With no doctor at my bed. She lifts the blanket and confirms that the baby has been delivered.  I lose myself in the reality of what is happening. What has happened. What happened weeks ago.  They bring over a small cloth; it looks no bigger than a wash cloth. They ask if I want to see the baby.  I can't. I'm too lost in the drugs and the grief and the shock of the day.  I nod. I cry. I do not remember what they did with my baby.  The dr arrives and apologizes that his surgery held him from us for so long.  He was saving a baby, saving a mom too, while my dead baby was being 'born?'  He performs a D&C and clears me.  As soon as the epidural wears off I can be discharged.  They assess that our baby had been a girl.  They can make fairly educated guess as to why the pregnancy failed, but they'll never know 100% for sure.  Her intestines were growing outside of her body.  They assure me, it's better this way. While some babies are born with this condition full term, their lives are painful and difficult and the condition cannot always be reversed and some die anyway.  This is told to me, in a reassuring tone.  It's better this way.  It's a kindness. It's the body's way of stepping it and saying-something's wrong, let's try again and next time we'll get it right.

My husband and I go home to our two healthy, beautiful children; we are shattered.  The grief weighs us down and we begin to drift. Hour by hour, day by day...month by month.  It lingers. The fear. The anger. The confusion.  I receive my insurance statement and on it reads:
Spontaneous Late Term ABORTION

While you, reader, may read or hear and understand my experience as a miscarriage, to the medical world, to the insurance world, to the GOVERNMENT, I had a late term abortion.  This realization stung and sent me spinning through more grief. More pain. More anger. More self loathing.  It is only in the most recent of time that I appreciate the gift that is having had this option available to me.  Without the laws that permitted this, I may have been sent home knowingly carrying a dead baby.  For two weeks my body continued to grow, and appear pregnant.  My body hadn't yet recognize that something had gone horribly wrong.   How much longer would it have taken?  Would it have made me ill?  Would I have had to endure all the pain and shame and guilt on my bathroom floor?  Would some of the tissue remained causing infection?  Would my children have had to watch my process in confusion and sadness?  Thankfully I do not have to wonder. Because this option WAS available. Because of this experience, and the myriad of emotional and mental and physical turmoil, I can tell you, this decision should NEVER belong to anyone outside of the woman and her doctor.  You cannot and should not get to judge or decide for another person what is best for them.  For their health. For their emotional health.  You may read this and say, well your baby was already dead-it's not the same.  I'm telling you, it is.

The insurance and medical and government world need very clear language. They need permission from laws to provide safe, sterile, medical care when things go wrong. For me, a dead baby is what went wrong. For the woman in the next room, her 'thing' that went wrong may be very different.  But I can tell you, it's not our place to decide for her.  You cannot carry this grief. It's never an easy, black and white decision with no consequence.  I do not love abortion. But I love that I did not have to endure this on my own.  I am not pro choice because I want to kill babies.  I am pro choice, because at one time, I needed what is medically termed, an abortion.  I still grieve her.  Every day I notice her missing from our lives.  I didn't tell many people about knowing our baby had been a girl. It made the experience too real.

 I was told when I started telling people about our pregnancy with the twins six months later, that God was giving us our baby back.  This statement was horrifying.  No matter if you think this is true, this statement is a painful and never helpful one to make-just so you're aware to never say this sort of thing to someone who is pregnant after losing a prior prengnacy.  This new pregnancy wasn't a do-over.  It wasn't God righting a horrible tragic wrong. No. I was not getting her back.  I was having boys.  Identical boys.  Identical boys who 1/2 way through the pregnancy I was once again given the option to abort due to severe TTTS.  Because of CHOICE, I was able to elect to not abort. We fought- Chris, the twins, the very talented and skilled medical teams and I, along with God and a legion of Heavenly help, and we brought those boys safely and healthy (for the most part) into our lives.  

It has been nearly 6 years.  I have four beautiful, exhausting, loving children.  We have our struggles, and most of the time I am so certain I could have never handled life with more. But I do feel her here with us.  Missing.  Ava longs for a sister, and sometimes I wonder if she remembers somehow deep within her, that we had promised her that she was getting one.  I sometime wonder at what point she'll be ready to hear that she very nearly did have one. Not today though. No, I'm not ready yet either.  Maybe when she becomes a mother? Or struggles to become one.  Maybe then I'll find the strengh my own mother had, to stand at her side, holding her hand and watching her tears and share our stories. Even then I hope I understand, and I ask of you to understand that you can never understand another person's experience wholly enough to judge. Even as a fellow miscarriage/abortion receiving person. You do not know the depth of another's circumstance or story. Life your life. Judge your life. Not ours.